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Cape Town - Sleep – or more accurately, lying in bed – is what most people spend a third of their lives doing. Yet many don’t realise the impact this seemingly passive activity has on their backs.
Orthopaedic surgeon Dr Attila Szabo says the only time during which the muscles, ligaments and other structures in the spine can completely relax is while sleeping. And when a person suffers from a back injury or disorder, it’s especially important to sleep well in order to help the healing process to repair strained muscles and soothe inflamed joints, says Szabo.
Physiotherapist with the MBW Physio practice Elizma van der Merwe says the facet joints and discs are “loaded” during daily activities, and the soft tissue contracts to help movement and to keep us in the upright position against gravity. During sleep, the discs are able to reabsorb water content and the soft tissue can relax.
This is why people must take care of how they sleep, as incorrect posture can strain your back and contribute to existing or the development of back pain.
Most experts agree that the best sleeping position is on the back with a small pillow tucked underneath the knees.
Szabo says the position allows for the natural curve of the lower back.
The most common sleeping position is on the side, with legs and hips aligned and flexed. This position often leaves the upper leg unsupported and the knee slides forward to rest on the mattress. This then rotates the lower spine, and could cause back or hip pain. To combat this, place a pillow between the knees and thighs.
Van der Merwe says sleeping on the back and side keeps the spine in a neutral position, and unloads the stress on the spine.
The worst position for the back is sleeping on the stomach. Van der Merwe says in this position you have to rotate your head to one side. The arch in the lower back is increased, putting more pressure on the facet joints.
Szabo advises those who can’t sleep any other way, to place a pillow under the pelvis and lower abdomen. This should reduce the strain on the back.
People also have certain back conditions which can influence their sleeping position. Szabo says patients with pain from osteoarthritis of the facet joints – those found in the spine – may prefer to sleep in the foetal position. This helps open up the joints in the spine and can relieve pressure there. Sleeping in a reclining chair or an adjustable bed which allows the head and knees to be elevated can also help.
Those with pain from degenerative disc disease may prefer to sleep on their stomach as this can relieve pressure on the disc space. They may feel most comfortable using a relatively firm mattress and placing a flat pillow under the stomach and hips, which can further reduce stress on the lower back.
Sufferers of spinal stenosis may prefer to sleep on their sides with their knees curled up in the foetal position. This helps relieve pressure on the nerve root. As with osteoarthritis, these patients could also try sleeping in a reclining chair.
Szabo adds that sleeping on the wrong mattress can cause sleeplessness, back pain, and overall aches and pains. For people with a back problem, a mattress that isn’t a good fit can make the pain worse.
The lowdown on the best lie-down
Mattresses are not really at the forefront of important things to tend to. Until you can’t sleep because the springs are poking your thighs, or it feels like you’re sleeping on a slab of concrete.
With so many options, selecting a mattress can seem daunting. For the average person, physiotherapist Elizma van der Merwe says the bed must have a firm base and the mattress should provide enough spinal support.
Another factor to consider is weight. “The problem is often with couples where the husband and wife have different body weights,” says Van der Merwe.
An egg-shell mattress could be used on the side of the lighter partner.
JP Ebersohn, branch manager of The Bed Centre in Montague Gardens, says weight is an issue no one wants to discuss, even though most beds cater only for 90kg per person.
“If you weigh more than 90kg, you need to talk about it (with the salesperson) or you may be wasting your money,” says Ebersohn.
Obese people need a good support system, and an extremely soft bed is out of the question. While there aren’t many, firmer beds are made to accommodate people of 130kg to 150kg.
Age is another factor, says Ebersohn. While it depends on personal preference, younger people tend to prefer firmer beds. “When you reach your forties to fifties, you need more comfort.”
The bed has two components: springs or coils for support, and padding for comfort. Many older people choose spring mattresses with thicker padding as comfort becomes a priority.
In general, the higher number of coils and the thicker the padding, the higher quality – and more expensive – the mattress.
However, orthopaedic surgeon Dr Attila Szabo warns people to beware of advertising gimmicks.
“Claims that a mattress is orthopaedic or medically approved should be viewed sceptically.
“There has not been extensive medical research or controlled clinical trials on the topic of mattresses and lower back pain,” says Szabo.
Ebersohn agrees. He says many companies pay chiropractors or other professionals to endorse their products. He says a mattress costing more than R4 000 is classified as an “orthopaedic” mattress, but urges people to research the products they intend to buy.
And when walking into the shop, the most important thing you can do is lie down on the bed on your side, since this is the position in which most people sleep. Then, it’s up to the individual to decide what works best for them, says Ebersohn. - Cape Argus